Effects Of Xuebijing On The Insulin Resistance And Prognosis Of Patients With Sepsis

Objective:To investigate the effects of Xuebijing injection on insulin resistance and prognosis of patients with sepsis and its relative mechanisms.Methods:1.Sixty sepsis patients enrolled in our ICU were randomly divided into two groups: control group(n=30) and Xuebijing-treated group(n=30).All the patients met the criteria formulated in 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference.The patients' reasons for intensive care included biliary infection,gastrointestinal perforation,intestinal obstruction,gangrenous appendicitis, and so on.The patients had neither advanced cancer nor pancreatic diseases;and had no history of obesity,diabetes,cardiovascular disorder or other metabolic diseases. The fasting glucose level of patients exceeded 6.1mmol/L,which meeting the criteria for insulin resistance(according to one of the indicators in WHO presence of metabolic syndrome).2.Patients in control group were treated with conventional therapy,including anti-infection,mechanical ventilation,continuous renal replacement therapy,and so on. The therapies in Xuebijing-treated group were similar with those ones in control group, except for intravenous injection of xuebijing in a dose of 100ml once a day,for one week.All the patients were fed continuously with total parenteral nutrition for 7 days, without usag of growth hormone,glucocorticoid,and so on.The patients who remained in ICU less than 7 days were exclued.3.During the first three days,we controlled the blood glucose at a level between 6.1 and 8.3mmol/L with infusion of insulin(50IU of RI in 50ml of 0.9 percent sodium chloride) by using a pump.Three days later,a continuous infusion of insulin was strated only if the blood glucose level exceeded 12mmol/L,and the infusion was adjusted to maintain the level at a value between 10.0 and 11.1mmol/L.We detected the capillary blood glucose once every four hours and regulated the injection velocity of the pump according to blood glucose level.4.The fasting plasma glucose concentration(FPG),fasting insulin concentration(FINS), C reactive protein(CRP) were detected respectively when the 1st day and the 7th day after patients were enrolled in ICU.Homeostasis model assessment(HOMA) was used to calculate the index of insulin resistance(HOMA-IR).The ratios between the amount of glucose and insulin used during the first three days(G/RJ)(g/u) were calculated.5.Acute Physiological Chronic Health Evaluation(APACHE)Ⅱscore and Marshall score were calculated to evaluate the patients' condition.The 28-day mortality was used to assess the prognostic outcome of patients in two groups.Results:1.The mean value of the first 3 days' G/RI((?)=(G/RI1+G/RI2+G/RI3)/3) in Xuebijing-treated group was increased significantly,compared with control group (4.5±1.45 vs 3.3±1.09,p=0.032).The values of WBC(p=0.020),CRP(p=0.021),FPG (p=0.047),FINS(p=0.022),HOMA-IR(p=0.014) were reduced significantly in Xuebijing-treated group than those ones in control group.2.The values of APACHEⅡscore(p=0.048) and Marshall score(p=0.041) were reduc -ed significantly in Xuebijing-treated group than those in control group.There was significant difference in the 28-day mortality between two groups(Xuebijing-treated group 30.0%,control group 56.7%,p=0.037).3.The values of CRP,APACHEⅡscore and Marshall score were positively correlated with HOMA-IR(p＜0.0001,p=0.027,p=0.004 respectively).Multiple factor Logistic regression revealed that the patients with the elevated values of APACHEⅡscore, Marshall score and HOMA-IR had significantly high risk of 28-day death(p=0.030, p＜0.0001,p＜0.0001 respectively).Conclusion:1.Xuebijing can reduce the insulin resistance.2.Xuebijing can reduce the insulin resistance in patients with sepsis,and improve the prognosis of these patients by controlling blood glucose.3.The mechanism might relate to the effect of anti-inflammation of Xuebijing.